Why Front-End Eligibility Is the Number One Denial Prevention Impact
Christina Slemp identifies three upstream areas where investment in tools and process creates the highest denial prevention impact at UNC Health. The top priority is eligibility: front-desk teams face high turnover and difficult training conditions, and any tool that makes eligibility verification easier at that point of care represents the highest-ROI upstream intervention available. The second priority is surgical authorization accuracy: when what was ordered and what was performed diverge, payers can give as little as 24 hours to update the authorization, so a rapid identification process is critical. The third is a longer-term goal: payers and providers reaching consensus on medical necessity definitions before claims are submitted rather than resolving the disagreement at the back end.
Key Takeaway
Eligibility and surgical authorization accuracy are two denial prevention levers that any organization can address immediately, and eligibility alone represents the single highest-ROI intervention available to front-end teams. Medical necessity consensus between payers and providers is harder and longer-term, but it is the only durable solution for that denial category.
“However we can make it the easiest for the front end to get those eligibility checks, it’s the number one impact that we can make.”
Christina Slemp, System Vice President of Revenue Cycle Financial Services, UNC Health
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